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<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Manuel S. Enverga University : Web-based Integrated Information System</title>
<link rel="shortcut icon" href="{dir_image}favicon.ico">
<link rel="stylesheet" type="text/css" href="{dir_css}Popup.css" />
</head>
<body>

	<div class="title-frame">Account Information</div>
	<div class="title-sub">
		Update this profile, as necessary, to ensure that we have accurate, up-to-date information.
	</div>
	<div class="popup-spacer"></div>
	<form method="post" enctype="multipart/form-data" action="">
	<input type="hidden" name="txtusername" class="text-input" value="{txtusername}"/>
	<input type="hidden" name="txtdept_id" class="text-input" value="{txtdept_id}"/>
	
		<table width="480" border="0" cellspacing="0" cellpadding="0">
			<tr>
				<td width="110" height="28">Account/Student #</td>
				<td width="10">:</td>
				<td width="350"><strong>{log_account_no}</strong></td>
			</tr>
			<tr>
				<td height="28">First Name<span class="required-field">*</span></td>
				<td>:</td>
				<td><input type="text" name="txtfname" class="text-input" value="{txtfname}" {w_txtfname}/></td>
			</tr>
			<tr>
				<td height="28">Middle Name<span class="required-field">*</span></td>
				<td>:</td>
				<td><input type="text" name="txtmname" class="text-input" value="{txtmname}" {w_txtmname}/></td>
			</tr>
			<tr>
				<td height="28">Last Name<span class="required-field">*</span></td>
				<td>:</td>
				<td><input type="text" name="txtlname" class="text-input" value="{txtlname}" {w_txtlname}/></td>
			</tr>
			<tr>
				<td height="28">Birthdate<span class="required-field">*</span></td>
				<td>:</td>
				<td>
				<select name="txtbdatemm" id="txtbdatemm" class="select-month-input" {w_txtbdatemm}>
					<option value="">--- Month ---</option>
					<option value="01" {selected01}>January</option>
					<option value="02" {selected02}>February</option>
					<option value="03" {selected03}>March</option>
					<option value="04" {selected04}>April</option>
					<option value="05" {selected05}>May</option>
					<option value="06" {selected06}>June</option>
					<option value="07" {selected07}>July</option>
					<option value="08" {selected08}>August</option>
					<option value="09" {selected09}>September</option>
					<option value="10" {selected10}>October</option>
					<option value="11" {selected11}>November</option>
					<option value="12" {selected12}>December</option>
				</select>
				<input type="text" class="select-day-input" name="txtbdatedd" id="txtbdatedd" value="{txtbdatedd}" maxlength="2" {w_txtbdatedd}/>
				<input type="text" class="select-year-input" name="txtbdateyy" id="txtbdateyy" value="{txtbdateyy}" maxlength="4" {w_txtbdateyy}/>
				
				</td>
			</tr>
			<tr>
				<td height="28">Gender<span class="required-field">*</span></td>
				<td>:</td>
				<td>
					<select name="txtgender" class="select-month-input" {w_txtgender}>
						<option value="">--- Gender ---</option>
						<option value="male" {selectedmale}>Male</option>
						<option value="female" {selectedfemale}>Female</option>
					</select>
				</td>
			</tr>
			<tr>
				<td height="28">E-mail Addres<span class="required-field">*</span></td>
				<td>:</td>
				<td><input type="text" name="txtemail" class="text-input" value="{txtemail}" {w_txtemail}/></td>
			</tr>
			<tr>
				<td height="28">Contact #<span class="required-field">*</span></td>
				<td>:</td>
				<td><input type="text" name="txtcontact" class="text-input" value="{txtcontact}" {w_txtcontact}/></td>
			</tr>
			<tr>
				<td height="28">Home Address<span class="required-field">*</span></td>
				<td>:</td>
				<td><input type="text" name="txtaddress" class="text-input" value="{txtaddress}" {w_txtaddress}/></td>
			</tr>
			<tr>
				<td height="28">Guardian</td>
				<td>:</td>
				<td><input type="text" name="txtguardian" class="text-input" value="{txtguardian}"/></td>
			</tr>
			<tr>
				<td height="28"></td>
				<td></td>
				<td><input type="submit" name="subButton" class="submit-input" value="Update"/> <span class="record-saved-color">{saved_record}</span></td>
			</tr>
		</table>
	</form>
	<div class="popup-spacer"></div>
	<div class="message-content"></div>
</body>
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